Determinants of childbirth care quality along the care continuum in limited resource settings: A structural equation modeling analysis of cross-sectional data from Burkina Faso and Côte d’Ivoire

Introduction Despite the important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries. This situation is attributed to poor childbirth care quality. The reason why women delivering in health facilities do not always receive care of an adequate standard is unclear. We assessed the determinants of childbirth care quality along the care continuum by means of different approaches. Methods A health facility-based cross-sectional study with a direct observation of health care workers’ practices while caring for mother–newborn pairs was carried out in Burkina Faso and Côte d’Ivoire. The performance of a set of essential best practices (EBPs) was assessed in each birth event at the admission, prepushing and immediate postpartum stages. A quality score, in the form of the additive sum of EBPs effectively delivered, was computed for each stage. We used negative binomial regression models and a structural equation modeling analysis to assess the determinants of care quality at each stage and the relationships of the quality delivered at the different stages, respectively. Results A total of 532 and 627 mother–newborn pairs were evaluated in Burkina Faso and Côte d’Ivoire, respectively. In both countries, delivery care quality varied significantly at all stages between health districts. Predelivery care quality was consistently higher in referral hospitals than in primary health care facilities (incident rate ratio (IRR) = 1.02, p < 0.05, and IRR = 1.10, p < 0.05, respectively, for Burkina Faso and Côte d’Ivoire). Quality at admission was poorer among nurses than among midwives in Burkina Faso (IRR = 0.81, p < 0.001). Quality at the admission and predelivery stages was positively correlated with immediate postpartum care quality (β = 0.48, p < 0.001, and β = 0.29, p < 0.001, respectively). Conclusion Quality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum.

Effectiveness of SIM on Knowledge Regarding Childbirth Care among Upcoming Fathers

Background: In the decade that followed since the original clinical report on the fathers role was published by the American Academy of Paediatrics in May 2004, there has been a surge of attention and research on fathers and their role in the care and development of their children. Methods: For this research, true experimental pre-test post-test research design has been adopted. The study was conducted in selected hospital of Wardha district. Pre experimental one group pre-test post-test research design was used and sample size was 60.Non probability purposive sampling technique was used. Results: 13.33% of upcoming fathers had poor knowledge level and 51.67% of upcoming fathers had average level of knowledge score in pre-test, 35% upcoming fathers had good level knowledge score in pre test. In post test 1.67% of upcoming father had good level of knowledge score, 55% of upcoming father had very good level of knowledge score and 61.67% of upcoming father had excellent level of knowledge score and none of them had poor and average level of knowledge score. Conclusion: It is concluded that self instruction module was found to be effective in improving the knowledge of childcare among upcoming father.

Experiences of health care providers on pregnancy and childbirth care during the COVID-19 pandemic in Iran: a phenomenological study

Background Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic. Methods This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers. Data were analyzed using Colaizzi’s seven stage method with MAXQDA10 software. Results Data analysis led to the extraction of 3 themes, 9 categories, and 25 subcategories. The themes were as follows: “Fear of Disease”, “Burnout”, and “Lessons Learned from the COVID-19 Pandemic”, respectively. Conclusions Maternal health care providers experience emotional and psychological stress and work challenges during the current COVID-19 pandemic. Therefore, comprehensive support should be provided for the protection of their physical and mental health statuses. By working as a team, utilizing the capacity of telemedicine to care and follow up mothers, and providing maternity care at home, some emerged challenges to maternal care services can be overcome.

Measuring facility readiness to provide childbirth care: a comparison of indices using data from a health facility survey in Ethiopia

BackgroundActionable information about the readiness of health facilities is needed to inform quality improvement efforts in maternity care, but there is no consensus on the best approach to measure readiness. Many countries use the WHO’s Service Availability and Readiness Assessment (SARA) or the Demographic and Health Survey (DHS) Programme’s Service Provision Assessment to measure facility readiness. This study compares measures of childbirth service readiness based on SARA and DHS guidance to an index based on WHO’s quality of maternal and newborn care standards.MethodsWe used cross-sectional data from Performance Monitoring for Action Ethiopia’s 2019 survey of 406 health facilities providing childbirth services. We calculated childbirth service readiness scores using items based on SARA, DHS and WHO standards. For each, we used three aggregation methods for generating indices: simple addition, domain-weighted addition and principal components analysis. We compared central tendency, spread and item variation between the readiness indices; concordance between health facility scores and rankings; and correlations between readiness scores and delivery volume.ResultsIndices showed moderate agreement with one another, and all had a small but significant positive correlation with monthly delivery volume. Ties were more frequent for indices with fewer items. More than two-thirds of items in the relatively shorter SARA and DHS indices were widely (>90%) available in hospitals, and half of the SARA items were widely (>90%) available in health centres/clinics. Items based on the WHO standards showed greater variation and captured unique aspects of readiness (eg, quality improvement processes, actionable information systems) not included in either the SARA or DHS indices.ConclusionSARA and DHS indices rely on a small set of widely available items to assess facility readiness to provide childbirth care. Expanded selection of items based on the WHO standards can better differentiate between levels of service readiness.

Title Determinants of the Quality of Childbirth Care Along the Continuum in Limited Resource Settings: A Structural Equation Modeling Analysis of Cross-sectional Data from Burkina Faso and Côte d’Ivoire

Introduction: Despite important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries. This situation is attributed to the poor quality of childbirth care. The reason why women delivering in health facilities do not always receive standards of care are unclear. We assessed the determinants of the quality of childbirth care along the continuum of care using different approaches.Methods: A health facility-based cross-sectional study with a direct observation of health care workers’ practices while caring for mother-newborn pairs was carried out in Burkina Faso and Côte d’Ivoire. The performance of a set of Essential Best Practices (EBPs) was assessed in each birth event at admission, pre-pushing and immediate post-partum stages. A quality score, in the form of the additive sum of EBPs effectively delivered was computed for each stage. We used negative binomial regression models and a structural equation modeling analysis to respectively assess the determinants of the quality of care at each stage and the relationships between the quality delivered at the different stages.Results: a total of 532 and 627 mother-newborn pairs were included respectively in Burkina Faso and Côte d’Ivoire. In both countries, the quality of delivery care varies significantly at all stages between health districts. The quality of predelivery care was consistently higher in referral hospitals as compared to primary health care facilities (IRR = 1.02; p < 0.05 and IRR = 1.10; p < 0.05 respectively for Burkina Faso and Côte d’Ivoire). The quality at admission was poorer in nurses as compared to midwives in Burkina Faso (IRR = 0.81; p < 0.001). The quality at admission and pre-delivery stages were positively correlated with the immediate post-partum quality (β = 0.48;p < 0.001 and β = 0.29;p < 0.001 respectively).Conclusion: Quality improvement strategies must target both providers and health facilities and different inputs are needed depending on the stage in the continuum of care.

A desinformação e sua relação com a violência obstétrica: uma revisão integrativa

Esta pesquisa teve por objetivo evidenciar como a desinformação corrobora com o acontecimento da violência obstétrica. Revisão integrativa que analisou 18 artigos na base de dados da Biblioteca Virtual em Saúde e Google scholar e foram utilizados como critérios de seleção: artigos publicados nos últimos 5 anos, disponíveis na íntegra e nos idiomas: Português, Inglês e Espanhol. Foram excluídos estudos de revisão integrativa e os artigos sem concordância objetiva e direta com o tema. A falta de conhecimento, a falta de humanização na assistência ao parto e a falha no acolhimento à gestante são as principais contribuintes para que a violência obstétrica ocorra. É necessário que a mulher seja instruída sobre seus direitos como gestante, parturiente e puérpera para que se torne sujeito ativo no que diz respeito ao período perinatal.Descritores: Assistência ao Parto no Brasil, Desinformação, Violência em Parturientes, Violência Obstétrica. Disinformation and its relationship with obstetric violence: an integrative reviewAbstract: This research aimed to show how misinformation corroborates the occurrence of obstetric violence. Integrative review that analyzed 18 articles in the database of the Virtual Health Library and Google Scholar and were used as selection criteria: articles published in the last 5 years, available in full and in the languages: Portuguese, English and Spanish. Integrative review studies and articles without objective and direct agreement with the topic were excluded. Lack of knowledge, lack of humanization in childbirth care, and failure to welcome pregnant women are the main contributors to obstetric violence occurring. It is necessary that the woman is instructed about her rights as a pregnant woman, parturient and postpartum woman so that she becomes an active subject with regard to the perinatal period.Descriptors: Childbirth Care in Brazil, Disinformation, Violence in Parturients, Obstetric Violence. La desinformación y su relación con la violencia obstétrica: una revisión integradoraResumen: Esta investigación tuvo como objetivo mostrar cómo la desinformación corrobora la ocurrencia de violencia obstétrica. Revisión integradora que analizó 18 artículos de la base de datos de la Biblioteca Virtual en Salud y Google Scholar y se utilizaron como criterio de selección: artículos publicados en los últimos 5 años, disponibles íntegramente y en los idiomas: portugués, inglés y español. Se excluyeron los estudios de revisión integradora y los artículos sin un acuerdo objetivo y directo con el tema. La falta de conocimiento, la falta de humanización en la atención del parto y la falta de acogida de mujeres embarazadas son los principales factores que contribuyen a que se produzca la violencia obstétrica. Es necesario que la mujer sea educada sobre sus derechos como mujer embarazada, parturienta y posparto para que pueda convertirse en un sujeto activo con respecto al período perinatal.Descriptores: Atención al Parto en Brasil, Desinformación, Violencia en Parturientas, Violencia Obstétrica.

Repeated cesarean section and vaginal delivery after cesarean section in São Paulo State in 2012

Objectives: describe mothers, pregnancies and newborns’ characteristics according to the type of childbirth history and to analyze repeated cesarean section (RCS) and vaginal delivery after cesarean section (VBACS), in São Paulo State in 2012. Methods: data are from the Sistema de Informações sobre Nascidos Vivos (Live Birth Information Systems). To find the RCS’s group, the current type of childbirth equal to cesarean section was selected and from these all the previous cesareans. To identify the VBACS’s group all live birth with current vaginal delivery were selected and from these all previous cesareans. Mothers with a history of RCS and VBACS were analyzed according to the characteristics of the pregnancy, newborn and the childbirth hospital. Results: 273,329 mothers of live birth with at least one previous child were studied. 43% of these were born of RCS and 7.4% of VBACS. Mothers who underwent RCS are older and higher educated and their newborns presented a lower incidence of low birth weight. Early term was the most frequent rating for gestational age born of RCS. Live births were of VBACS and had greater proportions of late term. The RCS was more common in hospitals not affiliated with the Sistema Único de Saúde (SUS) (Public Health System) (44.1%). Conclusion: the high RCS’s rates, especially in the private sector, highlight the necessity of improvements in childbirth care model in São Paulo.